Asian Rhinoplasty

Asian rhinoplasty is one of the most challenging ethnic rhinoplasties that plastic surgeons perform because of the thick skin and soft-tissue envelope. There are three goals: pleasing the patient, achieving an aesthetically appealing result, and preserving a natural look. Of these goals, the most arduous is to satisfy the patient, as many patients have unrealistic goals and may desire an extremely narrow Western nose. Furthermore, patients may bring in celebrity or model photographs and expect that outcome, even though it may not be suitable for their face or appear over-resected and pinched. The surgeon’s most important task is to attempt to persuade the patient that this result is nonfunctional, esthetically unfit, and difficult to achieve with their skin. For ethnic surgery, a clear and thorough grasp of nasal anatomy, function, and surgical techniques is paramount. An extensive preoperative discussion, including expectations, outcomes, and a detailed list of potential complications with the patient can prevent physician-patient miscommunication. Before surgery, it is essential to review the office examination, previous operative summary, photographs, nasal analysis sheet, problem list, and plan before proceeding with the surgical treatment.

Asian rhinoplasty is one of the most challenging ethnic rhinoplasties that plastic surgeons face primarily secondary to the lack of nasal dorsum and weak cartilaginous framework in combination with thick skin and soft-tissue envelope. Three goals that should be achieved are as follows:

1.

Pleasing the patient
2.

Achieving an aesthetically pleasing and functional result
3.

Maintaining a natural look.

Of these goals, pleasing the patient can prove to be the most difficult to achieve, because many patients possess unrealistic expectations and a desire to achieve an aquiline Caucasian nose. The patients may envision noses similar to those of models or celebrities, even though it may not be suitable for their faces, because of their lack of awareness of the underlying nasal structures. The surgeon’s most important task is to attempt to convince the patient that this result is unrealistic, nonfunctional, aesthetically unpleasing, and difficult to achieve with his or her thick skin. Only when this task is accomplished, with good communication and understanding of realistic outcomes between the surgeon and patient, may the surgery proceed with caution.

One of the most common problems in Asian rhinoplasty is the desire to achieve a less bulbous, Westernized nasal tip. To attain a defined nasal tip, aggressive over-resection of lower lateral cartilages is usually performed. When aggressive lower lateral cartilage reduction occurs, this usually causes the following problems: loss of projection, counterrotation (ptosis), loss of support, nasal obstruction, more bulbous nasal tip, and possible long-term nasal tip contour irregularities.

Modern rhinoplasty practices suggest that less is more and that aggressive cartilage removal is antiquated. Less cartilage removal, additional nasal support through structural grafting, and tip-suturing techniques are being advocated at national and international facial plastic meetings, suggesting that these techniques may lead to decreased revision rhinoplasties.

This article describes the Asian nasal anatomy, rhinoplasty goals, preoperative nasal evaluation and surgical planning, surgical sequence and techniques, postoperative care, risks and complications, and pearls.

Anatomy

A brief description of the Asian nose is discussed and the descriptions described are present in most, but not all, typical Asian noses ( Fig. 1 A, B). These include the following:

•

Thick skin with abundant fibrofatty tissue
•

Deep, low, and inferiorly set radix
•

Short, broad, and flat nasal bones with low nasal bridge and dorsum
•

Wide, bulbous, thick-skinned, deficient, ptotic, nasal tip with abundant, fibrous, nasal superficial muscular aponeurotic system (SMAS), broad domes, minimal tip definition, flimsy and weak lower lateral cartilages
•

Short and retracted columella
•

Wide, thick, horizontal ala with flaring nostrils
•

Retracted, acute nasolabial angle (less than 90 degrees) nasolabial junction with under-developed nasal spine.